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HX64066525 
RD81  L9735  An  improved  mstrume 


'RUMENT 
\  INING        AN 
iR-WAY,     during 
l  anesthesia 

:-:ph  e.  i.umbard,  m.d. 

NEW  YORK 
Instructor  in  Anesthesia.  University 
and  Bellevue  Hospital  Medical  College  ; 
jthetif.t  to  Bellevue  and  Allied  Hos- 
pitals, H.irlem  Divi.sion.  Lutheran. 
knioketl>.    ker,  and  L,ying-In  Hospitals 


REPRINTED  FROM 
THB 

MEDICAL  RECORD 
November  25,  1916. 


WILLIAM  WOOD  &  COMPANY 

NEW    YORK. 


RECAP 


^_ 


/w    I 


Columbia  (Bntoetgitp 

College  of  ipfjpattiang  anb  burgeons 
library 


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AN     IMPROVED     INSTRUMENT    FOR    MAIN- 
TAINING   AN    ORAL    AIR-WAY,    DURING 
GENERAL  ANESTHESIA. 

By  .1«  ISEPH    E.    LUMBARD,    M.D., 

NEW    VORK. 

tNSTBUCTOR     IX     ANESTHESIA,     UNIVERSITY     AND     BELLBVTJE     HOS- 
PITAL    MEDICAL     COLLEGE;     ANESTHETIST     TO    BELLEVUE     AND 
ALLIED     HOSPITALS,     HARLEM     DIVISION,    LUTHERAN, 
KNICKERBOCKER,    AND    LYINQ-IN     HOSPITALS. 

I.\  previous  articles"  I  mentioned  the  importance 
of  keeping  a  free  oral  air-way  during  general  anes- 
thesia and  described  my  invention  for  that  purpose. 
Since  then  I  have  changed  the  instrument,  making 
it  smaller  and  stronger.  Inasmuch  as  all  anes- 
thetists fully  agree,  which  is  saying  much,  that  too 
great  emphasis  cannot  be  placed  upon  the  necessity 
of  keeping,  a  free  oral  air-way  for  certain  condi- 
tions, I  feel  justified  in  harping  on  my  hobby  and 
have  succeeded  in  making  a  more  perfect  device. 
During  the  last  few  years  numerous  tubes  have 
appeared  for  the  same  purpose  made  by  Hewitt, 
Connell,  Ferguson,  Coburn,  Flagg,  and  Pinneo. 
In  the  second  of  the  articles  above  mentioned  I 

*Helps  in  Surgical  Anesthesia.  Journal  A.  M.  A.. 
November  23,  1912,  p.  L853.  A  Controller  of  the 
Tongue  and  Palate  During  General  Anesthesia,  Journal 
A.  M.  A.,  May  22,  L915,  i>.  L757. 

.  ri^ht,    William    Wood   &    Company. 

1 


call  my  instrument  "A  Controller  of  the  Tongue 
and  Palate  During  General  Anesthesia."  While 
this  is  possibly  more  correct  than  the  new  title,  it 
is  lengthy  and  ambiguous. 


jWjj 

to  JL '..&?/  // 

i  FJ 

in 

ill 

% 

Fig.  1. 


-Lumbard's  air-way  ;  the  lower  is  the  pharyngeal  end. 
Two-thirds  actual  size. 


My  latest  instrument  (see  Fig.  1)  for  maintain- 
ing an  artificial  oral  air-way,  is  constructed  as  fol- 
lows :  a  double  row  of  three  curved  wires  running 
parallel,  about  an  eighth  of  an  inch  apart,  are  firmly 


held    together   by   three  crossbands.     The   instru- 
ment is  41/2  inches  long,  V2  inch  in  width  and  % 


Pio.  -      Lurabard'a  air-way  In  situ. 

3 


inch  in  thickness.  It  contains  nine  pieces  and  is 
nickel  plated.  Properly  made,  it  will  not  rust  nor 
come  apart  when  sterilized. 


Via.  3. — Lumbard's  air-way  with  rubber  tube  attached  for  the 
insufflation   method    or    oxygen.      Two-thirds   actual    size. 

No  attempt  should  be  made  to  introduce  this  in- 
strument until  the  patient  is  well  anesthetized,  for 


the  pharynx  is  one  of  the  last  reflexes  to  yield  to 
general  anesthesia  and  the  introduction  of  the  in- 
strument too  soon  is  apt  to  cause  gagging.  The 
instrument  is  easily  introduced  by  inserting  the 
pharyngeal  end  between  the  tongue  and  the  soft 
palate  until  it  rests  in  the  pharynx  (see  Fig.  2). 
Should  the  respirations  become  noisy  this  annoy- 
ance can  be  overcome  by  extending  the  head  back- 
ward. Sometimes  the  noisy  breathing,  when  the 
tube  is  in  situ,  is  indicative  of  a  light  anesthesia. 
In  such  cases  it  is  better  to  take  the  tube  out  and 
deepen  the  anesthesia  before  replacing  it.  A  few 
cases  will  do  better  if  traction  on  the  tongue  is 
made  before  the  air-way  tube  is  introduced;  in 
such  cases  do  not  use  the  tongue  forceps,  but  al- 
ways make  traction  with  a  piece  of  dry  gauze  held 
between  the  fingers.  A  swollen  tongue  from  crude 
instrumentation  will  often  cause  the  patient  more 
trouble  than  the  operation  itself. 

The  instrument  does  not  interfere  with  any  face 
mask  nor  with  any  method  for  administering  a 
general  inhalation  anesthetic.  Not  only  does  this 
air-way  obviate  the  task  of  holding  the  jaw  for- 
ward, but  is  useful  in  the  aged  where  the  lips  ob- 
struct the  air  passage. 

I  have  often  noticed  when  instructing  interns  and 
students  that  they  are  quick  to  see  and  appreciate 
the  advantages  of  this  instrument.  I  would 
earnestly  recommend  the  use  of  this  tube  in  all 
abdominal  operations,  especially  when  in  the  Tren- 
delenburg position;  also  when  there  is  any  obstruc- 
tion to  free  respiration  during  anesthesia.  Keep- 
ing the  instrument  in  situ  after  the  operation,  un- 
til swallowing  returns,  will  greatly  hasten  the  re- 
covery from  the  anesthetic.  I  consider  an  instiu- 
ment  for  maintaining  an  artificial  oral  air-way  one 


of  the  most  important  items  of  an  anesthetist's  out- 
fit. 

A  free  oral  air-way  is  indicated  in  the  following 
conditions:  When  there  is  (1)  cyanosis  due  to  ob- 
structed nasal  or  oral  breathing;  (2)  unrelaxed 
muscular  condition,  due  to  faulty  breathing;  (3) 
enlarged  tongue  or  falling  back  of  the  tongue,  espe- 
cially when  the  patient  is  in  the  Trendelenburg 
position. 

When  using  the  insufflation  method  or  oxygen,  a 
rubber  tube  can  be  easily  attached  to  the  side  of 
the  instrument  by  a  rubber  band  or  string.  (See 
Fig.  3.) 

The  insufflation  method  and  oxygen  can  also  be 
used  with  Lumbard's  vapor  mask,  with  the  air-way 
tube  in  situ. 

The  substitution  of  free  oral  respiration  for  im- 
perfect nasal  or  oral  respiration  will,  in  a  great 
majority  of  cases,  immediately  be  followed  by 
slower  and  quieter  breathing,  improvement  in  color, 
and  greater  muscular  relaxation;  in  fact,  a  much 
improved  type  of  anesthesia  is  the  result. 

The  following  are  the  advantages  of  this  tube, 
each  of  which  removes  several  disadvantages  in 
similar  instruments:  (1)  It  will  not  clog  with  mu- 
cus, thus  eliminating  the  chief  defect  of  other  in- 
struments. (2)  It  is  easily  and  quickly  inserted. 
(3)  It  is  easily  kept  in  position,  whereas  the  weight 
of  a  solid  tube  often  displaces  it.  (4)  It  cannot  be 
compressed  by  the  teeth  and  gums.  (5)  It  will  not 
conduct  a  fluid  anesthetic  to  the  pharynx,  an  acci- 
dent liable  to  occur  with  other  tubes.  (6)  It  may 
also  be  used  on  children  as  well  as  adults.  (7)  It 
is  quickly  cleaned  and  sterilized,  because  it  is  open 
on  all  sides.  This  tube  has  well  been  called  the 
"sine  qua  non"  of  the  anesthetist. 

1927  Sevknth  Avenue. 

6 


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RD81 
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1*9735 


COLUMBIA  UNIVERSITY  LIBRARIES  fhsl.stx) 

RD81L9735C.1 

An  improved  instrument  for  maintaining  a 


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